Efficacy of various treatment modalities for nCOV‐2019: a systematic review and meta‐analysis

Misra, Shubham; Nath, Manabesh; Hadda, Vijay; Vibha, Deepti

BACKGROUND: Several therapeutic agents have been investigated for treatment of novel Coronavirus‐2019 (nCOV‐2019). We conducted a systematic review and meta‐analysis to assess the efficacy of various treatment modalities in nCOV‐2019 patients. METHODS: A literature search was conducted before 29 June 2020 in PubMed, Google Scholar, Cochrane library databases. A fixed‐effect model was applied if I(2) <50%, else results were combined using random‐effect model. Risk Ratio (RR) or Standardized Mean Difference (SMD) along‐with 95% Confidence Interval (95%CI) were used to pool the results. Between‐study heterogeneity was explored using influence and sensitivity analyses and publication bias was assessed using funnel plots. Entire statistical analysis was conducted in R version 3.6.2. RESULTS: Fifty studies involving 15 in‐vitro and 35 clinical studies including 9170 nCOV‐2019 patients were included. Lopinavir‐Ritonavir was significantly associated with shorter mean time to clinical recovery (SMD ‐0.32; 95%CI ‐0.57 to ‐0.06), Remdesivir was significantly associated with better overall clinical recovery (RR 1.17; 95%CI 1.07 to 1.29) and Tocilizumab was associated with less all‐cause mortality (RR 0.38; 95%CI 0.16 to 0.93). Hydroxychloroquine was associated with longer time to clinical recovery and less overall clinical recovery. It additionally had higher all‐cause mortality and more total adverse events. CONCLUSION: Our meta‐analysis suggests that except in vitro studies, no treatment has shown overall favorable outcomes in nCOV‐2019 patients. Lopinavir‐Ritonavir, Remdesivir and Tocilizumab may have some benefits while Hydroxychloroquine administration may cause harm in nCOV‐2019 patients. Results from upcoming large clinical trials may further clarify role of these drugs.